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PubMed1982

On the relationship between free plasma and saliva amitriptyline and nortriptyline.

Conflicting results on the correlation of tricyclic levels in plasma and saliva have raised doubts about the clinical usefulness of monitoring these drugs in the latter body fluid. However, saliva drug levels may reflect the free plasma concentration, which possibly determines its level in the brain. In two groups of depressive patients, the evolution was studied of the levels of amitriptyline and nortriptyline in plasma (as free and total) and in saliva, after the administration of amitriptyline. The results show a poor correlation between total plasma and saliva concentration of amitriptyline and nortriptyline, respectively. Levels of both tricyclics in saliva exceed by far those measured in plasma dialysate. However, the relationship is such that free plasma concentrations may be predicted from those measured in saliva, if one takes into account saliva pH at the moment of collecting the sample.

Amitriptyline↗
PubMed1982

Viloxazine in the treatment of endogenous depression. A standard (amitriptyline) controlled clinical study.

In a double-blind clinical trial with 20 patients suffering from endogenous depression statistically significant changes (improvement) were present in the scores of all assessment instruments. Although no statistically significant differences occurred between the groups, significant improvement on the HAM-D occurred earlier for amitriptyline and significant improvement occurred earlier on HAM-A for viloxazine. 2 patients were discontinued due to adverse reactions; one for nausea and vomiting while receiving viloxazine and one for paroxysmal atrial tachycardia while receiving amitriptyline. The same number of TES occurred for each group with seven unique to viloxazine (numbness, tingling, palpitation, ejaculation difficulty, nausea/vomiting, diarrhea, epigastric pain and gustatory disturbances) and seven unique to amitriptyline (insomnia, irritability, syncope, tremor, nasal congestion, orthostatic hypertension and paroxysmal atrial tachycardia). Other than for 1 patient who developed syncope and orthostatic hypotension and the patient who developed paroxysmal atrial tachycardia, there were no clinically significant changes in pulse rate, blood pressure and weight. There were no clinical laboratory findings with either drug that were judged to be pathological.

Adolescent↗
PubMed1980

Urinary MHPG and clinical response to amitriptyline in depressed patients.

The authors treated 18 rigorously diagnosed depressed patients with amitriptyline after baseline urine samples were collected for the measurement of 3-methoxy-4-hydroxphenylglycol (MHPG). Neither age nor severity of depression before treatment correlated with MHPG excretion. There was also no significant correlation between baseline MHPG excretion and clinical response at the end of at least 25 days' treatment with amitriptyline. The authors discuss the relevance of amitriptyline and nortriptyline plasma levels to MHPG and the noradrenergic/serotonergic theories of depression.

Adolescent↗
PubMed1978

A comparative clinical trial of mianserin (Norval) and amitriptyline in the treatment of depression in general practice.

A double-blind controlled comparative trial of mianserin (Norval) and amitriptyline was conducted in general practice. Fifty-one patients were treated with amitriptyline and fifty-five with mianserin. The dosage for the first week was 25 mg t.d.s. for amitriptyline and 10 mg t.d.s. for mianserin, increasing to 50 mg t.d.s. and 20 mg t.d.s. respectively for the subsequent three weeks. Both drugs proved equally effective in relieving the symptoms of primary depression but mianserin showed a reduced incidence of side-effects which was statistically significant.

Adolescent↗
PubMed1981

A double-blind study of dothiepin hydrochloride (Prothiaden) and amitriptyline in out-patients with masked depression.

A group of forty patients who presented to their general practitioner with depression or somatic complaints, which were considered to be due to depression, were included in a double-blind trial of dothiepin and amitriptyline. Patient improvement as judged by the Hamilton Rating Scale (HRS) and the Comprehensive Psychopathological Rating Scale (CPRS) indicated that both groups significantly improved over the 6 week period. Only in one comparison, CPRS after 1 week, was there any statistical difference between the groups and in this case dothiepin produced a better response than amitriptyline (p less than 0.05). Statistical analysis of side-effects indicated that the frequency and severity of certain individual side-effects, hypotension, tiredness/sleepiness and dry mouth were significantly less with dothiepin than with amitriptyline at Week 1 (p less than 0.05). The overall incidence and severity of side-effects was also less with dothiepin at all assessments during the trial.

Adult↗
PubMed1983

Timed-release dihydroergotamine in the prophylaxis of mixed headache. A study versus amitriptyline.

A pharmacological trial has been carried out on 41 out-patients suffering from mixed headache. The prophylactic effect of a timed-release dihydroergotamine formulation was tested versus amitriptyline. Patients reported daily, on appropriate cards, the hours of headache and the degree of pain during the month before therapy and on the following two months of treatment. Whereas amitriptyline was found to be more effective than dihydroergotamine in reducing headache intensity, timed-release dihydroergotamine was found significantly more effective than amitriptyline in reducing attacks of "migraine" type.

Adolescent↗
PubMed1994

A five year review of fatal self-ingested overdoses involving amitriptyline in Edinburgh 1983-'87.

One hundred and twelve cases of fatal self-ingested overdoses were investigated in the Forensic Medicine Unit of the Department of Pathology of the University of Edinburgh in the period 1983-'87 (inclusive). Of these, 24 cases involved amitriptyline as either the sole agent or in combination with another drug, the most common of which was ethanol. The mean age of the latter group was 43 years with a marked female preponderance. The social history was documented with six out of the 24 cases living alone and five out of the 24 cases divorced. The number previously referred for psychiatric treatment and the number of cases where over 100 tablets of the drug had been prescribed at any one time (where known) was recorded: eight out of 24 cases. The fact that amitriptyline was by far the commonest of the tricyclic antidepressants to be encountered in a fatal overdose situation raises the important question of the prescribing of amitriptyline as a first line therapy in mental depression.

Adolescent↗
PubMed1976

A single-blind comparative study of once daily dothiepin ("Prothiaden") and divided daily doses of amitriptyline.

Forty-eight patients took part in a single-blind clinical trial comparing a once daily dose of dothiepin (75 mg) and 25 mg 3-times a day of amitriptyline. The results showed that dothiepin caused a greater improvement than amitriptyline after 4 weeks of treatment as judged by depression scores, total scores and global assessments. The incidence of side-effects was less with dothiepin and in those patients who actually reported side-effects the severity was much less with dothiepin than with amitriptyline.

Adult↗
PubMed1977

Amitriptyline and weight gain: a biochemical and endocrinological study.

A study was carried out in 6 healthy volunteers to test the hypothesis that weight gain associated with amitriptyline treatment may be due to hypoglycaemia caused by increased circulating blood insulin. Subjects were treated with 50 mg amitriptyline b.d. for 28 days. Estimations made of serum levels of amitriptyline and its metabolite nortriptyline showed a steady state by the 10th day. No significant weight-gain was observed in any of the volunteers, although 2 reported an increase in appetite. There were no significant differences in any of the glucose tolerance curves, fasting or peak insulin levels or in the glucose/insulin curves for Days 0, 14 and 28.

Amitriptyline↗
PubMed1985

Controlled, double-blind, randomized trial of amitriptyline in relieving articular pain and tenderness in patients with rheumatoid arthritis.

Thirty-six patients with definite or classical rheumatoid arthritis participated in a double-blind, randomized, placebo-controlled trial to assess the effectiveness of adding amitriptyline to the treatment regimen for the relief of pain not adequately controlled by non-steroidal anti-inflammatory drugs. Dosage of amitriptyline was increased gradually up to 25 mg 3-times daily and patients were followed up for 12 weeks. Assessments were made of joint pain and tenderness every 4 weeks. The results showed no difference between the amitriptyline and placebo-treated patients for either parameter.

Adult↗
PubMed1980

A double-blind comparison of dothiepin and amitriptyline in patients with primary affective disorder: serum levels and clinical response.

In a double-blind parallel group study, thirty-two patients suffering from a primary affective disorder received either dothiepin or amitriptyline. Serum concentrations of total dothiepin plus northiaden or amitriptyline and nortriptyline were estimated. A similar therapeutic response was seen with both drugs but there was no correlation with serum concentrations of amitriptyline or nortriptyline, whereas serum dothiepin correlated positively with clinical response.

Adult↗
PubMed1980

The peripheral anticholinergic activity of tricyclic antidepressants: comparison of amitriptyline and desipramine in human volunteers.

The effects of three single oral doses (25 mg, 50 mg and 100 mg) of amitriptyline and desipramine, and of placebo, were compared on a range of cholinergic functions (resting pupil diameter, pilocarpine-evoked miosis, baseline-sweating, carbachol-evoked sweating, salivation, heart rate) in eight healthy volunteers. Three measures (pilocarpine-evoked miosis, carbachol-evoked sweating and salivation) reflected the antimuscarinic property of the antidepressants; in two tests (pilocarpine-evoked miosis and salivation) amitriptyline appeared to be more potent than desipramine. Resting pupil diameter was not affected by amitriptyline, whereas desipramine caused mydriasis, indicating that pupil size is not a reliable measure of anticholinergic activity in the case of drugs which also affect adrenergic mechanisms. Baseline-sweating and heart rate were not affected by the antidepressants.

Adult↗
PubMed1982

A controlled comparison of flupenthixol decanoate injections and oral amitriptyline in depressed out-patients.

Sixty-eight depressed out-patients were allocated to treatment with either oral amitriptyline (75-225 mg/day) or intramuscular flupenthixol decanoate (10-30 mg every 14 days) in flexible dosage for 12 weeks under double-blind procedures. Various observer- and self-rating scales were applied before and after 2, 4, 8 and 12 weeks of treatment. Twenty-four patients completed the course of amitriptyline and 20 the course of flupenthixol. All variables improved over time, but there were no significant differences between the two drugs. The Newcastle scores pre-treatment were not related to drug response suggesting that both drugs were similarly effective across a wide spectrum of depressive disorders. Patients on amitriptyline tended to complain of dry mouth; those on flupenthixol had a higher incidence of extrapyramidal signs, the majority receiving anti-parkinsonian drugs at some time during the treatment. Flupenthixol decanoate in low dose is a useful anti-depressant, but should be restricted to short courses of treatment, to patients refractory to other treatments, and to patients suspected of poor compliance.

Administration, Oral↗
PubMed1987

A controlled comparison of fluoxetine and amitriptyline in depressed out-patients.

Fluoxetine, a selective serotonin uptake inhibitor (mean dose 73 mg each morning) was compared with amitriptyline (mean dose 122 mg at night) in a double-blind study of 64 depressed out-patients. Fifty patients completed the 6-week trial. The drugs did not differ with respect to psychiatrists' ratings, but amitriptyline was slightly superior with respect to patients' ratings. The amitriptyline-treated group had complaints of dry mouth and dizziness on standing; the fluoxetine-treated group of sleep disturbances, nausea, and headaches.

Adult↗
PubMed1981

Amitriptyline-induced ophthalmoplegia.

Total external ophthalmoplegia, unresponsive to caloric stimulation, was observed in a gravid woman who had ingested approximately 1.0 to 1.5 gm of amitriptyline. The intravenous administration of 4.0 mg physostigmine salicylate (PS) produced a revival of consciousness and reflex activity but had no appreciable effect on ocular motility. A prior case report of amitriptyline-induced ophthalmoplegia in a patient who took lesser amounts of the medication described immediate restoration of eye movement with only 2 mg of intravenous PS. The action of the amitriptyline on the vestibuloocular reflex seems to involve cholinergic transmission and the effect of the drug may be dose related.

Adult↗
PubMed1982

Amitriptyline versus placebo in postherpetic neuralgia.

To study the effects of amitriptyline in treating postherpetic neuralgia, 24 patients were randomly assigned to either drug or placebo in a double-blind crossover study. We found good to excellent pain relief in 16 of 24 patients (p less than or equal to 0.001). We did not find an antidepressant effect in most patients (p greater than 0.05). The median dose of amitriptyline was 75 mg. The median blood level was 65 ng per milliliter, and of nortriptyline 30 ng per milliliter. Good responses were maintained in 12 of 22 patients. Amitriptyline is useful in treating postherpetic neuralgia and may not act as an antidepressant.

Aged↗
PubMed1988

Amitriptyline in the treatment of headache in patients with Parkinson's disease: a double-blind placebo-controlled study.

We evaluated the effect of 25 mg bid amitriptyline on muscle contraction headache in 36 patients with Parkinson's disease in a randomized double-blind placebo-controlled study. Treatment lasted 12 weeks, and we assessed the efficacy by number of days with headache, sum-of-severity score (intensity X number of days with headache), and consumption of analgesics. We also administered Hoehn-Yahr staging, the Webster Rating Scale, the Mini-Mental State, and the Zung Self-Rating Depression Scale. We assessed the patients after a 4-week run-in period and after 4, 8, and 12 weeks of treatment. Thirty-one patients (15 in the amitriptyline group and 16 in the placebo group) completed the trial. Amitriptyline reduced the intensity and the frequency of headache, whereas the placebo did not. The Zung Depression Scale and the Webster Rating Scale findings remained unchanged.

Adult↗
PubMedDate not supplied

Discrepancies between pharmacokinetic studies of amitriptyline.

In this article, studies on the disposition of amitriptyline after administration of a single dose, as well as following long term administration are reviewed. While long term studies showed bias towards a higher mean apparent oral clearance, studies in normal subjects nevertheless indicated a higher apparent oral clearance than that calculated from steady-state concentrations in depressed patients. Methodological issues could account for some of the discrepancies in mean values of the pharmacokinetic parameters of amitriptyline. Broad individual variability in the elimination rate of amitriptyline has been confirmed but could not be attributed to the clinical characteristics of the subjects.

Amitriptyline↗